Introduction to Basic Nursing Care

Nurses and other health care clinicians can work in a variety of settings caring for many
different populations of people. Some of these settings provide inpatient care to patients, such
as hospitals or nursing homes, while others focus on outpatient type care, such as home health
care. Nurses care for diverse populations of patients, both in age and in position along the
health/illness continuum. One of the main goals in nursing care is to promote health and
prevent illness. This is a goal for all our patients of any age. We care for both healthy and
unhealthy newborns, children, adults, and older adults and provide interventions that are
aimed at maintaining wellness and restoring health. The human body is remarkable and can
heal from many serious conditions, including severe trauma, infectious diseases, and many
other alterations in health. Sometimes, however, people develop conditions that cannot be
cured despite the many modern advances in medicine. The end result of medicine that cannot
reverse the process of illness eventually will be death. Sometimes death is unexpected, as from
an accident, while other times it can be anticipated, as when chemotherapy is no longer
effective for a person diagnosed with an advanced form of cancer. The majority of these deaths
will occur in a healthcare setting, which is where most nurses work. Nurses working in
healthcare settings not only provide care to people who are restoring their health, but also to
those who are dying. It is essential that nurses and other clinicians have the knowledge and
skills to care for patients who are dying and their families who are dealing with impending loss.
In the Institute of Medicine (IOM) report, Approaching Death: Improving Care at the End
of Life (1997), the consensus of committee members is that every healthcare professional who
will care for dying patients and families’ needs to have a basic educational preparation in order
to be able to provide both competent and compassionate care. Although national efforts such
as the development of End of Life Nursing Education Consortium (ELNEC) have increased the
number of nurses and nurse faculty trained in end-of-life care, there continues to be a lack of
preparedness in end-of-life care competency among nurses. Previous research has found only
one in four nurses feel confident in caring for dying patients and their families, and that less
than 2% of overall content in nursing textbooks were related to end-of-life care (Kirchoff,
Beckstrand, Anumandla, 2011; Ferrell, Virani, & Grant, 1999). Despite the tremendous growth
in palliative and end-of-life care programs across the country, very few nursing education
programs provide adequate education on this topic for our future nurses. Most end-of-life care
content is scattered throughout nursing programs, if at all, and there usually is no specific
course or textbook that focuses on the subject. Although only a small percentage of nurses
practice in the specialty of palliative care and hospice, all nurses should have educational
preparation in end-of-life care because of the widespread contact nurses have with people at
the end of life.
 Perhaps the greatest message this book hopes to bring to students learning a healthcare
profession is about the power of your voice. This is one area in which you don’t need to have a
4.0 grade point average to make a difference in the life of your patient. Yet, practicing effective
communication with patients is often the least practiced skill during nursing school. More of an
emphasis is often placed on honing in on other more technical skills such as administration of
injections, sterile technique, or insertion of a urinary catheter. While acquiring competence and
confidence in all the aforementioned skills is essential during nursing school, so is acquiring
competence and confidence in effective communication skills. This is a vital part of the role of
any professional health care clinician when communicating to patients, families, and other
members of the healthcare team. If one doesn’t possess confidence in their basic
communication skills with patients on routine matters, than other more difficult kinds of
communication encounters, such as with persons who are actively dying or with families who
have just lost a loved one, will be the upmost challenge. Yes, nurses will continue to provide
competent care in the “technical skills” associated with nursing; however, they will often
overlook and refrain from engaging in the type of communication which this book is dedicated
to fostering.
It is especially vital to patients and families going through this process to be able to have
healthcare professionals who they can have open communication with. The goal of this book is
to introduce students to the reality that interactions will happen with patients that are
uncomfortable. Being a nurse or other healthcare professional does not exclude us from having
difficult or uncomfortable conversations with people. These will occur and it is important to be
prepared for it. What would you do or say when you walk into a room to give your patient their
scheduled medication and they say to you, “So did you hear, I only have 2 weeks left” or “I am
done with that awful chemo, I want to go home and die.” Your natural inclination might be to
ignore what you heard, administer the medication, and quickly leave the room. In my 20+ years
in healthcare, I have witnessed this outcome more times that I can count. Nurses do not avoid
these conversations because they are not knowledgeable, or because they do not care. In fact,
they care very much and do not know how to respond in a way that they perceive is helpful to
the patient. They do not want to say the wrong thing. At the end of life, however, saying
nothing is the wrong thing.